Medications PDF

MEDICATIONS o Must be witnessed or documented by wasting nurse and another nurse Assessment o...

MEDICATIONS o Must be witnessed or documented by wasting nurse and another nurse Assessment o Both should document this wasting ⮚ Drug allergies Legal Aspects ⮚ Injection site ⮚ Nurse practice acts ⮚ Patient’s condition ⮚ Responsibility for actions ⮚ Consent forms ⮚ Question any order that appears unreasonable Knowledge related to ⮚ Refuse to give the medication until order is 1. Legal aspects of HCARE clarified 2. Pharmacology 3. Pharmacokinetics 4. Life Sciences Questionable Order: 5. Pathophysiology 6. Human Anatomy 1. Contact prescribing doctor and clarify orders 7. Mathematics a. Pag di macontact, idocument lahat ng attempt na nireach yung doctor and Medical Legislation and Standards the reason for withholding the medication ⮚ Federal regulations b. Document o Pure food and drug act i. WHEN the physician was notified o FDA ii. WHAT was conveyed to the o MedWatch Program physician ⮚ State and local regulation of medication iii. HOW the doctor responded 2. If someone else gives the medication ⮚ Hcare institutions and medication law a. Document data about the condition of client before and after medication ⮚ Medication regulation and nursing practice 3. Incident report (Nurse Practice Acts) a. Clearly document factual information Guidelines for Safe Narcotic Administration/Controlled Nurse shall validate and question orders that are: Substances Incomplete Questionable ⮚ Kept under lock Illegible ⮚ Special Inventory forms Client’s allergies are determined, all contraindications for ⮚ Documentation requirements the medication as based on the client’s health problems and disease conditions are determined, prior to the ⮚ Counts of controlled substances administration of medication. Medicine – chemical substance used to promote Controlled Substances health, prevent illness, to diagnose, to alleviate or cure disease ⮚ Documented on narcotics record AS REMOVED Medication – substance administered for the ⮚ Documented on client’s medication record AS diagnosis, cure, treatment, or relief of a symptom or prevention of disease ADMINISTERED Drug – same as medication but also refers to ⮚ Wasted ILLICITLY obtained substance  Therapeutic Agents – drugs and ⮚ Absorption, distribution, metabolism, and pharmacological substances used to treat pathological conditions excretion of drugs to determine the relationship Pharmacology (Pharmakon) – broad science between the dose of a drug and the drug’s which includes all aspects of the subjects of concentration in biological fluids chemical substances that act upon cells; study of o Absorption the effect of drugs on living organisms ▪ Passage of medication Pharmacological Concepts molecules into the blood from the site of Medication Name administration o Generic Name – given before drug becomes officially approved ▪ Affected by o Official Name – name which drug is Route of listed in official publications administration o Chemical Name – chemical structure Ability of a of the drug and exact description of the medication to atoms or atomic groupings dissolve o Brand Name/Trade Name – assigned Blood flow to the by the manufacturer that appears site of frequently in the literature; name under administration which a manufacturer markets the Body surface area medication Lipid solubility Classification o Distribution o Effects of medication on body system ▪ Occurs within the body to o Symptoms the medication relieves tissues, organs, and specific o Medication’s desired effect sites of action ▪ Analgesic ▪ Antipyretic ▪ Depends on Physical and ▪ Anti-inflammatory chemical Medication Forms properties of o Solid medication o Liquid Physiology of the o Oral forms person o Circulation ▪ Topical o Membrane ▪ Parenteral permeability o Protein o Forms for instillation into body cavities binding Pharmacokinetics o Metabolism ▪ Metabolized into a ⮚ Study of how medications less-potent or an inactive o Enter the body form o Are absorbed and distributed into cells, ▪ Biotransformation occurs tissues, or organs o Reach their site of action under the influence of enzymes that detoxify, break o Alter physiological functions down, and remove active o Are metabolized chemicals o Exit the body ▪ Occurs in the liver  o Occurs immediately following the ▪ Kidneys, blood, intestines, administration of drugs and lungs play a role o Life-threatening o Excretion ⮚ Medication interaction ▪ Exit through o One medication modifies the action of Kidney another Liver Bowel Timing of Medication Dose Responses Lungs Exocrine glands Therapeutic Range Peak ▪ Chemical makeup of Trough medication determines the Biological half-life organ of excretion Plateau Time-critical medications Types of Medication Action Patient teaching ⮚ Therapeutic o Expected or predicted o Desired ⮚ Adverse o Unintended o Undesirable o Unpredictable ▪ Side Effect: Predictable, unavoidable Goal: achieve a constant blood level within a secondary effect safe therapeutic range Could be harmless o Between MEC and toxic concentration or harmful Minimum Effective Concentration (MEC) o Plasma level of medication below ▪ Toxic Effect: which the effect of the medication does Accumulation of not occur medication in the Serum fluctuates between doses bloodstream Peak varies ▪ Idiosyncratic reaction o Depending on pharmacokinetics of Overreaction or medication underreaction After peak, serum conc. falls progressively Diff. reaction from All medications have biological half-life normal o Time it takes for excretion processes to lower the amount of unchanged ⮚ Allergic medication by half o Unpredictable Maintenance of therapeutic plateau o Rash o Must receive regular fixed doses o Itching Time-critical medications o Hives o Medications in which early or delayed administration of maintenance doses ⮚ Anaphylactic o >30 mins before or after scheduled o Severe allergic reactions dose  o Most likely result in harm or subtherapeutic responses in a patient Routes 1. Oral a. Sublingual b. Buccal 2. Parenteral a. Intradermal b. Subcutaneous c. Intramuscular Nursing Knowledge Base d. Intravenous e. Other: ⮚ Safe admin. Is imperative i. Epidural, ii. intrathecal, ⮚ Nursing Process provides a framework for iii. intraosseous, medication administration iv. intraperitoneal, ⮚ Clinical Calculations v. intrapleural, vi. intraarterial o Conversions within one system f. Routes usually limited to physicians o Conversions between systems i. Intracardiac o Dose calculations ii. Intraarticular o Pediatric doses 3. Topical a. Skin ▪ Special caution b. Mucous membranes c. Generally have local effects Dose Calculation Methods 4. Inhalation Verify with another nurse to ensure accuracy 5. Intraocular Ratio and proportion Systems of Medication Measurement Dimensional Analysis o Cancellation method Require the ability to compute medication doses o Factor-label or unit factor method accurately and measure medications correctly o Can be multiplied by one without Metric system (0 before the decimal) changing its value o Logically organized o Meter, L, g Household system o Familiar to individuals o Prone to inaccuracy Solution Pharmacology o Metric – safety reasons o Apothecary system – weight measurements (dram, ounce, grain (gr), pound o Household measurements – for those at home or in another healthcare facility (tsp, tbsp, drops, oz, cups, pints, quart, gallons, punds)  Parts of a complete medication order Full name of client Time or frequency Date and time order route written Name of drug Signature of the one writing the order Ordered dosage and form of medication Prescription Order or directives for medication administration Physician is legally responsible Rx: take thou and per the inscription Inscription: contains drug name, strength, dose Signature: information to be written on the label o Directions on the patient Superscription: patient’s name, address, age, date issued DEA: practitioners who wish to prescribe Pediatric Dosage controlled substances must register with the FDEA (Federal Drug Enforcement Agency (for ⮚ Young’s Rule (1-12 yrs) prescribing controlled substances) o Age of child x Adult dose o Age of child +12 Type of Orders in Acute Care ⮚ Clark’s Rule (all age) ⮚ Standing/Routine o Weight in pounds x adult dose 150 o Until dosage is changed ⮚ Fried’s Rule (